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Nodular syphilitic scleritis masquerading as an ocular tumor.

Shaikh SI, Biswas J, Rishi P - J Ophthalmic Inflamm Infect (2015)

Bottom Line: The patient did not have any systemic illness or complaints suggestive of connective tissue disease.Rapid plasma reagin (RPR) test and Treponema pallidum hemagglutination assay (TPHA) were also positive, confirming the diagnosis of syphilis.Although rare, syphilis can present as nodular scleritis masquerading as ocular tumor.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, 18, College Road, Sankara Nethralaya, Nungambakkam, Chennai, 600006, Tamil Nadu India.

ABSTRACT

Background: Scleritis may be the initial or only presenting feature of systemic, autoimmune, or infectious disorders. Corticosteroids are the mainstay of treatment for immune-mediated scleritis. However, steroids could prove detrimental when used to treat infectious scleritis. Hence, infectious causes of scleritis should be ruled out.

Findings: A 47-year-old male from central India presented with swelling, pain, and redness in the left eye since 2 months. The patient was diagnosed elsewhere as having an extraocular extension of intraocular tumor and advised radiation brachytherapy for the same. Clinical examination revealed nodular scleritis in the left eye. The patient did not have any systemic illness or complaints suggestive of connective tissue disease. Laboratory investigations ruled out the same. However, Venereal Disease Research Laboratory (VDRL) test was positive. Rapid plasma reagin (RPR) test and Treponema pallidum hemagglutination assay (TPHA) were also positive, confirming the diagnosis of syphilis. Ultrabiomicroscopy (UBM) and ultrasound scan of the eye ruled out intraocular tumor. Treatment was initiated with benzathine penicillin 2.4 million units per week for 3 weeks to which the patient responded remarkably well.

Conclusions: Although rare, syphilis can present as nodular scleritis masquerading as ocular tumor. Syphilis must be considered in the list of etiological diagnoses in patients presenting with nodular scleritis, and testing for this disease should be a part of routine investigation in patients with scleritis.

No MeSH data available.


Related in: MedlinePlus

UBM image of the left eye showing homogenous mass arising from the episcleral and scleral tissue. No intraocular involvement is noted.
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Fig2: UBM image of the left eye showing homogenous mass arising from the episcleral and scleral tissue. No intraocular involvement is noted.

Mentions: Ultrasound biomicroscopy showed the presence of homogenous mass in the inferotemporal quadrant arising from the sclera and episclera without any intraocular involvement (Figure 2). Ultrasound B scan image of the left eye showed indentation by the scleral nodule. There was no evident intraocular pathology on USG B scan (Figure 3).Figure 2


Nodular syphilitic scleritis masquerading as an ocular tumor.

Shaikh SI, Biswas J, Rishi P - J Ophthalmic Inflamm Infect (2015)

UBM image of the left eye showing homogenous mass arising from the episcleral and scleral tissue. No intraocular involvement is noted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385283&req=5

Fig2: UBM image of the left eye showing homogenous mass arising from the episcleral and scleral tissue. No intraocular involvement is noted.
Mentions: Ultrasound biomicroscopy showed the presence of homogenous mass in the inferotemporal quadrant arising from the sclera and episclera without any intraocular involvement (Figure 2). Ultrasound B scan image of the left eye showed indentation by the scleral nodule. There was no evident intraocular pathology on USG B scan (Figure 3).Figure 2

Bottom Line: The patient did not have any systemic illness or complaints suggestive of connective tissue disease.Rapid plasma reagin (RPR) test and Treponema pallidum hemagglutination assay (TPHA) were also positive, confirming the diagnosis of syphilis.Although rare, syphilis can present as nodular scleritis masquerading as ocular tumor.

View Article: PubMed Central - PubMed

Affiliation: Shri Bhagwan Mahavir Vitreoretinal Services, 18, College Road, Sankara Nethralaya, Nungambakkam, Chennai, 600006, Tamil Nadu India.

ABSTRACT

Background: Scleritis may be the initial or only presenting feature of systemic, autoimmune, or infectious disorders. Corticosteroids are the mainstay of treatment for immune-mediated scleritis. However, steroids could prove detrimental when used to treat infectious scleritis. Hence, infectious causes of scleritis should be ruled out.

Findings: A 47-year-old male from central India presented with swelling, pain, and redness in the left eye since 2 months. The patient was diagnosed elsewhere as having an extraocular extension of intraocular tumor and advised radiation brachytherapy for the same. Clinical examination revealed nodular scleritis in the left eye. The patient did not have any systemic illness or complaints suggestive of connective tissue disease. Laboratory investigations ruled out the same. However, Venereal Disease Research Laboratory (VDRL) test was positive. Rapid plasma reagin (RPR) test and Treponema pallidum hemagglutination assay (TPHA) were also positive, confirming the diagnosis of syphilis. Ultrabiomicroscopy (UBM) and ultrasound scan of the eye ruled out intraocular tumor. Treatment was initiated with benzathine penicillin 2.4 million units per week for 3 weeks to which the patient responded remarkably well.

Conclusions: Although rare, syphilis can present as nodular scleritis masquerading as ocular tumor. Syphilis must be considered in the list of etiological diagnoses in patients presenting with nodular scleritis, and testing for this disease should be a part of routine investigation in patients with scleritis.

No MeSH data available.


Related in: MedlinePlus